痔瘘治疗新进展

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痔疮分类——混合痔
混合痔： 同一部位的 齿状线上下均发生痔疮，内 痔和外痔的症状同时存在
[12]Long, Q., et al. (2015). "[Clinical observation of auricular point sticking combined with western medicine for preventing and treating postoperative complications of external excision and internal ligation on mixed hemorrhoid]." Zhongguo Zhen Jiu 35(3): 237-240. [13]Zhou, X. H. (1987). "[404 mixed hemorrhoid patients treated with external excision and internal separation with high ligation]." Zhong Xi Yi Jie He Za Zhi 7(10): 598-600, 580-591.
蹲坑好还是马桶好？
耻骨直肠肌 肛门角
•[19] Dov, MD. Comparison of Straining During Defecation in Three Positions: Results and Implications for Human Health. Digestive Diseases and Sciences, 2003, Vol. 48, No. 7, pp. 1201–1205
痔疮分类——内痔
I度 II度 III度 IV度
部位：发生在齿状线以上
表面覆盖直肠粘膜 主要表现：排便时无痛性 出血和痔核脱出
分期
[6]Goligher JC. ADVANCES IN PROCTOLOGY. Practitioner 1964;193:526-32. [7]Gaj F, Trecca A, Busotti A et al (2002) The new classification of hemorrhoids: PATE 2000-Sorrento. History of the scientific debate. Minerva Chir57:331–339 [8]Fazio FW, Tjandra JJ. The management of perianal diseases. Adv Surg. 1995;29:59 –78.
痔疮分类——外痔
部位：齿状线以下，表面被皮肤覆盖
主要表现：肛门坠胀、疼痛、有异物感
分类：
静脉曲张性外痔
血栓性外痔
结缔组织外痔
炎性外痔
[9]Wronski, K. (2012). "Etiology of thrombosed external hemorrhoids." Postepy Hig Med Dosw (Online) 66: 41-44 [10]Zur, E. (2009). "Elegant compounded solutions for the treatment of thrombosed external hemorrhoids." Int J Pharm Compd 13(3): 192-195. [11]Gebbensleben, O., et al. (2009). "Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study." Clin Exp Gastroenterol 2: 69-74.
蹲坑好还是马桶好？
以色列的几个学者通过比较坐着和蹲着如厕，发现蹲着大便的 人主观上感觉更轻松，客观上排便时间减少三分之一[1]
日本的学者更是进一步的使用 X 线对排便过程进行扫描，最后
发现从坐位到蹲位，肛门角会扩大 100～126 度[2]
•[19] Dov, MD. Comparison of Straining During Defecation in Three Positions: Results and Implications for Human Health. Digestive Diseases and Sciences, 2003, Vol. 48, No. 7, pp. 1201–1205
蹲坑好还是马桶好？
VS
• • [19] Dov, MD. Comparison of Straining During Defecation in Three Positions: Results and Implications for Human Health. Digestive Diseases and Sciences, 2003, Vol. 48, No. 7, pp. 1201–1205 [20] Ryuji S; Kuniko T; Hiroyasu H; Osamu T; Megumi S; Masahiko K; Emina O; Hitoshi T; Tomoyuki U; Tomonori Y. Influence of Body Position on Defecation in Humans. Lower Urinary Tract Symptoms, 2010, 2, 16–21
一般治疗
饮食：增加膳食纤维摄入量或轻泻药的治疗 局部治疗： 1、 局部应用皮质类固醇软膏或外敷传统中药 2、 坐浴熏洗 保持良好的排便习惯
[16] Alonso-Coello P, Guyatt G, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Co-chrane Database Syst Rev.2005;CD004649. [17] Alonso-Coello P, Mills E, Heels-Ansdell D, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and met-analysis. Am J Gastroenterol. 2006;101:181–188. [18] TanKY, Seow-Choen F. Fiber and colorectal diseases: separating fact from fiction. World J Gastro-enterol. 2007;13:4161–4167.
痔病治疗的现状及新进展
中西医结合科 薛萍
主要内容
痔病相关知识概述 最新指南及共识推荐意见 痔病治疗新进展相关文献
直肠肛管解剖图
病因假说
病因假说
静脉曲 张学说 肛垫下 移学说 动脉血 流增加 不良的排便习 惯和便秘
[1]Buntzen, S., et al. (2013). "Diagnosis and treatment of haemorrhoids." Dan Med J 60(12): B4754. [2]Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis 2009;24:105-13. [3]Haas PA, Fox TA, Jr., Haas GP. The pathogenesis of hemorrhoids. Dis Colon Rectum 1984;27:442-50. [4]Aigner F, Bodner G, Gruber H, et al. The vascular nature of hemorrhoids. J Gastrointest Surg 2006;10:1044-50. [5]Riss S, Weiser FA, Schwameis K, Mittlbock M, Stift A. Haemorrhoids, constipation and faecal incontinence: is there anyrelationship? Colorectal Dis 2011;13:e227-33.
器械治疗
胶圈套扎法：将小型胶圈套入痔的根部，阻断内痔的血 运，使痔缺血 坏死、脱落而自愈
、
硬化疗法：在内痔的顶端注射3-5ml组织硬化剂，使曲张的
静脉发生炎症和纤维组织增生,使痔核硬化萎缩 红外线凝固法：用红外线照射引起痔组织内的蛋白质
变性进而止血，使肛垫固定不再脱垂而治愈
[21]Sekowska M,et al.Treatment of the hemorrhoids and anal mucosal prolaps using elastic band ligature-early and long term results[J].Pol Przegl Chir,2011,83:654-661 [22]痔临床诊治指南(2006版)[J]. 中华胃肠外科杂志. 2006(05) [23]CRH O′Regan套扎法治疗Ⅰ~Ⅲ度内痔的临床观察[J]胡宝春、马承华、王雷、李晗、夏小、刘保全、胡铁头2013（08）：3034-3036
Baidu Nhomakorabea 评估及检查
肛门视诊 ：检查有无内痔脱出，脱出内痔的部位、大小和
有无出血及外痔情况
肛管直肠指诊：I 、Ⅱ度内痔指检时多无异常；Ⅲ、Ⅳ度内
痔指检有时可触及齿状线上的纤维化痔组织
结肠镜或乙状结肠镜检查：直肠出血的痔患者
大便隐血试验：排除消化道肿瘤的常用筛查手段
[14]Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.Gastroenterology. 2008; 134:1570 –1595. [15]CappellMS. Reducing the incidence andmortality of colon cancer: mass screening and colonoscopic poly-pectomy. Gastroenterol Clin North Am. 2008;37:129–160.
•[20] Ryuji S; Kuniko T; Hiroyasu H; Osamu T; Megumi S; Masahiko K; Emina O; Hitoshi T; Tomoyuki U; Tomonori Y. Influence of Body Position on Defecation in Humans. Lower Urinary Tract Symptoms, 2010, 2, 16–21
•[20] Ryuji S; Kuniko T; Hiroyasu H; Osamu T; Megumi S; Masahiko K; Emina O; Hitoshi T; Tomoyuki U; Tomonori Y. Influence of Body Position on Defecation in Humans. Lower Urinary Tract Symptoms, 2010, 2, 16–21